Question:
What are the correct CPT codes for this situation?
“Biventricular defibrillator implant done: Right ventricular lead implant and coronary sinus lead implant. Post op x-ray could not see the leads. Went back into OR & removal dislodged CS lead implant of left bundle area lead & change of generator to a DF4/IS1 header. CS lead removal Venogram during prior implant showed lateral vein taking off from a separate ostium & the anterolateral branch not extending laterally. The middle cardiac was the only viable lead elected to remove the lead. Left bundle lead implant Medtronic C304 sheath was advanced to the RV septum over a glidewire. A Medtronic 3830 lead was used to map the septum in a unipolar configuration until a “W” pattern was found on V1. The lead was advanced into the septum while monitoring V1 configuration, impedance, LVAT, V6-V1 interpeak interval & QRS duration. Capture was confirmed in both unipolar & bipolar configurations. Sensing was satisfactory. There was no diaphragmatic stimulation with high output pacing. The sheath was split and removed.”
Answer:
Our thoughts – this sounds like 33249 and 33225 to start with, then, when they couldn’t see the LVL, the LVL had pulled back into the right atrium, so it was removed at this separate session (33244), and a new RV septal lead was placed with a new ICD generator (33249).
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